{"operation":"document","citation":"CPUC GO 112-F Appendix B","title":"CPUC General Order 112-F Appendix B - Report of Gas Leak or Interruption","source_type":"regulation","agency":"California Public Utilities Commission","status":"current","official":true,"published_on":"2015-06-25","effective_on":"2015-06-25","summary":"CALIFORNIA PUBLIC UTILITIES COMMISSION\n\nReport of Gas Leak or Interruption*\n\nCPUC File No. 420\n\nPart I: CPUC CONTACT INFORMATION\n\nOperator: | | CPUC Contact: Name | | Recorder | FAX\nContact Person | | | Date | | Time: (24hr) |\n| CPUC Information Request: Written Report | Sketch/Photo | FD Report\nPho","machine_formats":{"json":"https://regulus.evalyn.ai/document/ca-cpuc-go-112-f-appendix-b.json","markdown":"https://regulus.evalyn.ai/document/ca-cpuc-go-112-f-appendix-b.md"},"app_url":"https://regulus.evalyn.ai/document/ca-cpuc-go-112-f-appendix-b","source_url":"https://docs.cpuc.ca.gov/PublishedDocs/Published/G000/M163/K327/163327660.PDF","body":"CALIFORNIA PUBLIC UTILITIES COMMISSION\n\nReport of Gas Leak or Interruption*\n\nCPUC File No. 420\n\nPart I: CPUC CONTACT INFORMATION\n\nOperator: | | CPUC Contact: Name | | Recorder | FAX\nContact Person | | | Date | | Time: (24hr) |\n| CPUC Information Request: Written Report | Sketch/Photo | FD Report\nPhone: | | DOT Notified - Yes No | DOT Report Number: |\n\nPart II: INCIDENT DETAILS\n\nIncident Location | Incident Time | Reported to the Operator\nCity/County: | | Date | | Date: | | Time: (24hr) |\nAddress/Location: | | Time: (24hr) | | Reported by: |\nReason(s) for Reporting (check all that apply)\nGas leak associated with: | Emergency action required:\nDeath | Injury | $$Damage | Media Coverage | Traffic Rerouted | Area Blocked Off | Building Evacuated\nService Interruption | Operator Judgment | Other Emergency actions (describe) |\nTransmission Line Test Failure | Required Transmission Line Shutdown |\nIncident Cause | Dig In | Fire/Explosion | Construction Defect | Material Failure | Corrosion | Vehicle Impact | Suicide\nUNKNOWN - MORE INFORMATION TO FOLLOW | Other (describe) |\nEscaping Gas Involvement (check all that apply) | | Leak Only | Fire | Explosion | None\nSummary (Briefly describe the incident and the probable cause.) |\nGas Equipment Affected (check all that apply) | Specification of Failed Equipment | Injuries and Fatalities\nMain | Regulator | Meter | Valve | Material | Steel | Cast Iron | | None |\nService Line | Controls | Service Riser | Plastic | Copper | | Injuries | Fatalities\nCustomer Facility | Transmission Line | Other | | Company: | |\nOther (describe) | | Pipe Size MAOP | Operating Pressure | Other: | |\nDig In Information | Estimated Damage\nUSA notification required: Yes No | Name of Excavator: | | Damage to gas facilities: |\nUSA notified: Yes No | Excavator Contact Person: | | Other damage involving gas: |\nFacilities properly marked: Yes No | Phone: | | Total: |\nRecovery from Incident | Public Agencies on Scene | Customer Outage |\n| Date | Time (24hr) | |\nCo Personnel on Scene | | | Media | Police | Customers out of service | |\nGas flow stopped | | | Fire | Ambulance | Customer-hours outage | |\nService restored | | |\n\nPart III: CPUC INVESTIGATION\n\nIs further investigation warranted? Yes No | Signature of CPUC Engineer | |\nDate incident investigated: | | Field report attached? Yes No | CPUC Inspector: | |\n\n*The information contained in this report is provided solely for the confidential use of the Commission and its staff and is not open to public inspection (PUC GO 66-C, Public Utilities Code, Sections 315 and 583).","truncated":false,"body_characters":2567}